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By Sarah Renouf and Natalie Bisal, Research Health Psychologists, Health and Lifestyle Research Unit, Queen Mary University of London

Undoubtedly, smoking is one of the biggest causes of death and illness where every year around 100,000 people in the UK die from smoking, with many more living with debilitating smoking-related illnesses. Health psychologist like us focus on providing behavioural support through one to one and group work as well as using aids to support quitting, such as Nicotine Replacement Therapy (NRT) or Champix, a tablet which dulls cravings and decreases the pleasurable effect of smoking. Our clinic regularly provides a combination of support which is effective in increasing the chance of successfully quitting. But a new kid of the block has appeared which has challenged our thinking of smoking cessation; the e-cigarette.

Although the use of e-cigarette has risen dramatically over the past 10 years and is now the most popular smoking cessation aid in the UK, our knowledge and the research has not kept up with this development. Many people report that e-cigarettes can help address the habitual side to smoking that other medications can’t, such as the throat hit and hand-to-mouth action. However, there have been a spate of conflicting opinions of the harms of e-cigarettes from various media reports as well as from major health organisations such as NICE - which makes it difficult for the public to understand whether or not e-cigarettes are a useful way to quit smoking or a harmful alternative. Health psychology research has perhaps been surprisingly slow to react to this proliferation of e-cigarette use considering our focus on behavioural habits. Recent research is now emerging which highlights the potential positive impact of e-cigarettes where they are 95% less harmful than regular cigarettes and are associated with increased success rates of quit attempts. Despite these developments, the profession in general has been decidedly slow to adapt to developments, experts such as Professor Peter Hajek and Professor Robert West (who have been vocal supporters of the e-cig option) are the exception rather than the norm. More research is needed into the long-term effects of e-cigarettes and their potential in certain populations, such as pregnant women or those with mental health problems, where the greatest impact on their health might be seen. Health psychologists need to adapt to this ‘new kid on the block’ and are uniquely placed to explore the potential of e-cigarettes and investigate contexts in which they may not be helpful as well as explore barriers including some individuals discomfort with the idea of replacing one habit for another.

Within our clinic, we try to take an active role in adapting to these new developments where we seek to understand the concerns of e-cigarettes where our role can be one of educator to highlight the evidence which is emerging of the good safety record and benefits of e-cigarettes. We are also looking at using the proliferation of e-cigarette use to draw more people into our clinic, for example, we are currently partnering with local e-cigarette shops to make our service more attractive to quitters. We are also involved in research, including an ongoing trial comparing the effectiveness of e-cigarettes to NRT to increase our knowledge in this area. However, services like ours increasingly suffer threats to government funding which severely undermines our ability to continue this work and the long-term aim to reduce deaths and illness from smoking-related diseases – however something has to change if we are to continue to help address this health concern.

With the exception of five years “abroad”, I have lived and worked full time in the so-called “Luddite triangle” I am often (e.g., in my own home) accused of being a “Luddite”. On the face of it, my decision to negotiate life without a smartphone, Facebook or a Twitter account, probably justifies this response. On the other hand, my early adoption of iPod, unwavering insistence on Apple computers and addiction to gaming that is managed through abstinence, implies that perhaps people (e.g., my family) shouldn’t rush to judgement. May it further be noted that I also chose not to “invest” in laser discs, Sinclair C5’s or a pager.

Like the Luddites, I do not object to new technology per se, simply the unthinking introduction of new technology without adequate consideration of acceptability, feasibility and worth. In my opinion, new technology frequently is unthinkingly seen as the solution to a raft of problems, including the funding crisis in the NHS. Clearly, new technology will have a role to play in tackling the social and economic problems we face, but it should not be deployed unthinkingly. At the time of publication in 2013, Abroms et al. identified more than 400 smoking cessation apps (just one form of new technology), none of which had been subject to a randomised controlled trial, much less developed with an eye to theories and methods that health psychologists take for granted. What should have been an influential review published in the same year http://tinyurl.com/m932tpl concluded that: “Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base.” (p. 130, Bastawrous & Armstrong, 2013).

Although the picture since 2013 has changed somewhat, the pace of change in relation to using health psychology to inform interventions (electric or acoustic) is not matching the pace of the development of new technologies. The seeming willingness to embrace new technologies in spite of the lack of evidence is not trivial: fundamentally, new technology is a form of medical intervention, and new drugs and new surgical procedures are not rolled out until they have been shown to be safe, clinically effective and cost-effective. As an aside, perhaps the seeming willingness to embrace new technologies is because of the lack of evidence. After all, evidence can be messy and prompt the search for more and better evidence rather than providing a solution.

So, why this new technology gold rush? One explanation lies perhaps in the same processes that underpin “brain image bias” (McCabe & Castel, 2008 ), the finding that scientific explanations are more persuasive when accompanied by images of brains. Like images produced by fMRI scans, new technology is striking, memorable and appealing. Like the neuroscience underpinning the fMRI scans, the behavioural science underpinning new technology innovations can be good, bad or indifferent. What sticks in the memory is the scan or the gizmo. Maybe behavioural scientists should learn something from neuromarketing: a carefully-designed behavioural intervention that is effective if delivered via a leaflet is liable to be usurped by an app with no such underpinning evidence.

It is true that Luddites smashed new technology, but they did not do so unthinkingly in opposition of new technology per se. They did so through a combination of disenfranchisement, a legal system that benefitted employers over employees and because the new technology had been implemented without adequate consideration of acceptability, feasibility and potential consequences. Maybe I am a Luddite after all.

When I find myself scanning through the TV channels of an evening looking for a way to unwind, it is often not long before I come across programmes telling me how to “lose weight well”, “give up drugs” or “trust them, they’re a doctor”. So fine, what’s the problem with that? Well, the problem with that is that often these programmes, although clearly well-intentioned, are presenting a model of behaviour change that we as health psychologists know is too simplistic, and therefore often fundamentally flawed. So where are we? Where are the health psychologists on these programmes? Why isn’t Dr Chris getting advice from his health psychology colleagues over how to over-come these barriers to changing behaviour? The problem is, I don’t know – I honestly have tried to ask him, but sadly so far he hasn’t come back to me.

The thing is I have to admit that I am a bit of a fan - of both Dr Chris and Dr Xand. I am sure if either ever do respond to my emails and tweets I will have to stop myself becoming a slightly star-struck fool. Indeed, I have spent many an hour watching Operation Ouch with my son, and laughed out loud at Dr X and’s satirical review of the health of 2016, Second Opinion. I believe their programmes are generally well-informed, well-intentioned and provide a necessary spotlight on areas of healthcare and health behaviour. So why am I still frustrated?

The answer is that the lack of health psychology research and expertise within these programmes, highlights quite clearly to me how far we as a Division, and as individual health psychologists, have to go in order to position ourselves more closely alongside our bio-medical colleagues. It is so important that we find a way to start to influence their perspectives and disseminate our findings in a way that actually gets to the people at the heart of the matter. The diet industry is huge and financially lucrative, the fact the message of there being a “diet for everyone” (you just need to buy the right book) still being prominent is something that we need to challenge. We also must accept that this is partially because the health psychology perspective, and the need to focus on supporting real long-term behaviour change, has not yet been fully heard.

Now I am not sure what the answer is and I am also not sure how to get some nice photogenic health psychologists on prime time TV, but I hope that someone with the Division does (and is more photogenic than I). If that is the case, then let’s get our heads together and try and push health psychology into the limelight. We need to continue to try and do this and fans or not, we need to try and get the likes of the van Tulleken twins to hear what we have to say and see how health psychology is a hugely positive addition to the good work they clearly want to achieve.

Since we are launching our blog on St Valentine’s Day, we decided to go with a suitably cheesy title. Those of you familiar with the Bond franchise will recognise this play on the words of one of Ian Fleming’s Bond books: ‘From Russia with love’. Now, although Bond was arguably very good at changing other people’s behaviour, his methods were inappropriate; he relied on force and/or charm (lies and inappropriate persuasion). If he was a practising psychologist, his actions would lead at best to him being hauled up on a disciplinary and more likely to being struck off the HCPC register.

Staying with the theme Valentine’s Day, and by implication love; Cupid carries two kinds of arrows, one with a sharp golden point, and the other with a blunt tip of lead. A person wounded by the golden arrow is filled with uncontrollable desire, but the one struck by the lead feels aversion and desires only to flee. So Cupid has the power to change behaviour too, but he takes a biomedical approach and essentially relies on drugs to ‘do the job’. I am sure that there are researchers out there looking for the panacea ‘behaviour-change pill’. However, in the mean time we, as behaviour change experts, must continue to work on finding ways to help people curb their unhealthy behaviours and increase healthy ones.

We are more in need of behaviour change experts (aka Health Psychologists) than ever. Many of the biggest risks to our health at present could be reduced if only we engaged in healthier behaviours. It is therefore our responsibility to continue our work on developing theories and models for behaviour change, as well as testing how well those models work in practice; not just in lab conditions, but out there in the ‘real world’ where practitioners are struggling with many competing demands. Our membership is made up of academics and practitioners. We need to work hand in hand with one another to ensure that we address both sides of this challenge.

This new blog may be one means of achieving this. We hope that you, our members will actively contribute to our blog – perhaps by writing your own pieces (max 500 words) or responding to a blog piece and giving an alternative view. We’d like you to share your experiences; perhaps challenges you have faced in your research and/or practice; maybe you want to comment on an issue in the news, or you might choose to write a piece to coincide with a particular health awareness day (e.g. Cancer awareness month or healthy vision month). Maybe you will write a think piece, a provocative piece, a timely piece, or maybe a piece that de-mystifies an area of Health Psychology. At the very least, we hope that through this blog we can spark some conversations and raise awareness about all things Health Psychology.